US20090005760A1 - Sealable endovascular implants and methods for their use - Google Patents

Abstract

The present invention is directed towards sealable and repositionable endovascular implant grafts, and methods for their use for the treatment of aortic aneurysms and other structural vascular defects. Sealable, repositionable endograft systems for placement in a blood vessel are disclosed, in which endograft implants with circumferential sealable collars and variable sealing devices upon deployment achieve a desired controllable seal between the collar and the vessel's inner wall. Embodiments of endovascular implants according to the present invention may further be provided with retractable retention tines or other retention devices allowing an implant to be repositioned before final deployment. An endograft system according to the present invention further comprises a delivery catheter to allow placement through a peripheral arteriotomy site, and of sufficient length to allow advancement into the thoracic or abdominal aorta.

Description

CROSS REFERENCE TO RELATED APPLICATIONS
• The present application claims priority of U.S. Provisional Patent Application Ser. No. 60/834,401, filed Jul. 31, 2006 and U.S. Provisional Patent Application Ser. No. 60/834,627, filed Aug. 1, 2006.
FIELD OF THE INVENTION
• The present invention relates to the field of vascular surgery and the treatment of aneurysms or other luminal vascular defects. Specifically, the present invention relates to a novel design for sealable endovascular implants and to methods of use for such implants in endovascular procedures for aneurysms of the thoracic or abdominal aorta or other vascular structural defects.
BACKGROUND OF THE INVENTION
• Aneurysms of the thoracic and abdominal aorta represent a degenerative process of the aorta that is often attributed to atherosclerosis. Aneurysms are defined as a focal dilatation with at least a 50% increase over normal arterial diameter, usually associated with a degradation of the aortic media, or other structural defect in the aortic wall.
• Medical research has suggested that these lesions are prone to occur in areas subjected to significant redirection of blood flow during diastole; however, the exact cause of such aneurysms is not known. A familial tendency to symptomatic aneurysms has been suggested. Degenerative aneurysms account for more than 90% of all infrarenal aneurysms of the abdominal aorta. Other potential causes include infection, cystic medial necrosis, arteritis, trauma, collagen vascular disorders, and anastomotic disruption.
• Abdominal aortic aneurysms most commonly begin in the infrarenal aorta, and extend down to the iliac bifurcation. Aneurysms of the thoracic aorta are most commonly located in the descending thoracic aorta, beginning just distal to the origin of the left subclavian artery.
• Aortic aneurysms generally affect elderly Caucasian men. Aortic aneurysms are less commonly reported among persona of African American, Asian, and Hispanic heritage. Abdominal aortic aneurysms are five times more common in men than in women. In men, the aneurysm process appears to begin at approximately age fifty years and reaches peak incidence at approximately age eighty years. Women appear to have a more delayed onset in which the aneurysm process appears to begin at approximately age 60 years. Smoking has been associated as a potential risk factor for the development of aortic aneurysms. Other risk factors include previous aneurysm repair or peripheral aneurysm (such as femoral or popliteal), coronary artery disease, and hypertension.
• Although the reported findings from autopsy series vary widely, the incidence of aortic aneurysms probably exceeds 3-4% in individuals older than 65 years. Death from aneurysmal rupture remains one of the 15 leading causes of death in the United States. In addition, the overall prevalence of aortic aneurysms has increased significantly in the last 30 years. This is partly due to an increase in diagnosis based on the widespread use of imaging techniques. However, the prevalence of fatal and nonfatal rupture has also increased, suggesting a true increase in incidence. An aging population probably plays a significant role.
• The surgical management of aortic aneurysms dates back to the early twentieth century, and has involved a variety of methods, including ligation, intraluminal wiring, cellophane wrapping, homografts, and grafts using nylon and polytetrafluoroethylene [PTFE] fabrics.
• Prior to the development of endoaneurysmorrhaphy in 1962, postoperative surgical mortality rates were high (>25%). Endovascular repair techniques have reduced the operative mortality to 1.8-5%.
• Existing techniques for endovascular treatment of aneurysms involve placement of a tubular graft with seals to normal aortic walls above and below the aneurysm to create a tubular bridge to carry flow across the aneurysm without allowing flow to fill the aneurismal sac. Using these techniques, grafts may be placed using percutaneous access to the femoral arteries, and delivery/implantation using vascular catheters and fluoroscopic visualization. The deficiencies associated with existing endograft technology relate to leakage at the graft/aortic interface and/or post-implantation migration of the endograft. Small post-implantation leaks may be repaired with the placement of one or more extension cuffs above the endograft proximally, or below the implant distally to attempt to obtain a better seal with the vessel. The required use of such cuffs may add significantly to the overall cost and morbidity of the procedure. Major failures with endograft repair generally require emergent open surgery to avert catastrophic rupture of the aneurysm. Also, current endovascular systems require accurate size matching of endograft implants, leaving a very small margin for error.
• In order for a patient to be a candidate for existing endograft methods and technologies, a proximal neck of at least 15 mm. of normal aorta must exist between the origin of the most inferior renal artery and the origin of the aneurysm in the case of abdominal aneurysms or the left subclavian artery for thoracic aortic aneurysms in order to permit an adequate seal. Similarly, at least 15 mm. of normal vessel must exist distal to the distal extent of the aneurysm for an adequate seal to be achieved.
• Migration of existing endografts has also been a significant clinical problem, potentially causing leakage and re-vascularization of aneurysms and/or compromising necessary vascular supplies to arteries such as the carotid, subclavian, renal, or internal iliac vessels. This problem has been partially addressed by some existing endograft designs, in which barbs or hooks have been incorporated to help retain the endograft at its intended site. However, these existing endograft designs are not removable and repositionable once they are deployed. Thus, once such an endograft has been placed, open surgery is necessary if there is failure due to leakage or undesired occlusion of other vascular structures.
• Because of the limitations imposed by existing vascular endograft devices and endovascular techniques, approximately eighty percent of abdominal and thoracic aneurysms repaired in the U.S. are still managed though open vascular surgery, instead of the lower morbidity of the endovascular approach.
SUMMARY OF THE INVENTION
• The present invention is directed towards a novel design for endovascular implant grafts, and methods for their use for the treatment of aortic aneurysms and other structural vascular defects. A sealable, repositionable endograft system for placement in a blood vessel is disclosed, in which an endograft implant comprises a non-elastic tubular implant body with an elastic proximal ends and an elastic distal end(s). Both the elastic proximal and distal ends in an implant according to the present invention further comprise one or more circumferential sealable collars and one or more variable sealing device, capable of controllably varying the expanded diameter of said collar upon deployment to achieve the desired seal between the collar and the vessel's inner wall. An endovascular implant according to the present invention further comprises a central lumen and one or more control leads extending distally from releasable connections with each variable sealing device. Embodiments of endovascular implants according to the present invention may further be provided with retractable retention tines or other retention devices allowing an implant to be repositioned before final deployment. An endograft system according to the present invention further comprises a delivery catheter with an operable tubular sheath, capable of housing a folded or compressed endograft implant prior to deployment and capable of retracting or otherwise opening in at least its proximal end to allow implant deployment, said sheath sized and configured to allow its placement via a peripheral arteriotomy site, and of appropriate length to allow its advancement into the thoracic or abdominal aorta, as required for a specific application.
• In use of an embodiment according to the present invention, an operator prepares an arteriotomy site in a patient in a suitable peripheral location, such as the femoral arteries. Upon incision into the artery, a guide wire is placed, and extended under radiographic visualization into the aorta. A catheter sheath is inserted, housing a collapsed endovascular graft. An injector cannula is inserted, with its proximal tip extending beyond the catheter sheath. Under radiographic visualization, radio-opaque or other contrast dye is injected into the injector cannula, and the contrast dye-enhanced view is used to position the proximal edge of the cannula above the beginning of the aneurysm sac. The catheter sheath is then partially retracted to expose the proximal portion of the endovascular implant. Through action initiated by the operator on the control leads, the variable sealing device for the proximal seal is activated, expanding the elastic circumferential sealable collar until firm contact is made with the vessel wall. At this point, additional radio-opaque or other contrast dye is injected, and the seal is assessed. If there are leaks, the variable sealing device is again activated to expand the diameter of the circumferential sealable collar for a firmer contact. The seal is reassessed and adjusted until there no contrast dye leaks are seen. If the radio-opaque or other contrast dye indicates that the device is placed too proximally and threatens or covers the renal or subclavian junctions, then it is loosened and moved distally.
• Once the proximal circumferential sealable collar has been suitably sealed, the catheter sheath is then retracted beyond the distal extent of the aneurysm exposing the remainder of the graft. The variable sealing device for the distal seal is similarly activated, expanding the elastic circumferential sealable collar until firm contact is made with the vessel wall. At this point, additional radio-or other contrast dye is injected, and the distal seal is assessed. If there are leaks, the distal variable sealing device is again activated to expand the diameter of the distal circumferential sealable collar for a firmer contact. The seal is reassessed and adjusted until there no contrast dye leaks are seen.
• For an implant for an abdominal aortic aneurysm according to the present invention, an endograft implant comprises a non-elastic tubular body with an elastic proximal and distal ends and a non-elastic contralateral cuff. An operator deploys and seals the proximal and distal ends of the implant as described above, with the distal end deployed and sealed in the iliac artery on the side of the initial arteriotomy. Then, a second arteriotomy is made on the opposite side. Radio-or other contrast dye injection is again used to allow visualization of the non-elastic contralateral cuff, and a second guide wire is placed from the second arteriotomy site through the non-elastic contralateral cuff. A contralateral delivery catheter is then introduced over the second guide wire. The contralateral delivery catheter comprises a slidable or removable sheath housing a folded or compressed endograft segmental implant which further comprises a non-elastic tubular body with an elastic proximal and distal ends. Both the elastic proximal and distal ends in an endograft segmental implant according to the present invention further comprise one or more circumferential sealable collars and one or more variable sealing device, capable of controllable varying the expanded diameter of said collar upon deployment to achieve the desired seal between the collar and the non elastic contralateral cuff proximally and between the collar and the vessel's inner wall distally. An endograft segmental implant according to the present invention further comprises a central lumen and one or more control leads extending distally from releasable connections with each variable sealing device.
• Again, under radiographic control, radio-opaque or other contrast dye is injected into the injector cannula, and the contrast dye-enhanced view is used to position the proximal edge of the contralateral delivery catheter within the lumen of the non-elastic contralateral cuff. The contralateral delivery catheter sheath is then partially retracted to expose the proximal portion of the endograft segmental implant. Through action initiated by the operator on the control leads, the variable sealing device for the proximal seal is activated, expanding the elastic circumferential sealable collar until firm contact is made between the sealable collar and the non elastic cuff. At this point, additional radio-opaque or other contrast dye is injected, and the seal is assessed. If there are leaks, the variable sealing device is again activated to expand the diameter of the circumferential sealable collar for a firmer contact. The seal is reassessed and adjusted until there no contrast dye leaks are seen.
• Finally, once the proximal circumferential sealable collar of the endograft segmental implant has been suitably sealed, the catheter sheath is then retracted beyond the distal extent of the aneurysm, exposing the remainder of the graft. The variable sealing device for the distal seal is similarly activated, expanding the elastic circumferential sealable collar until firm contact is made with the vessel wall. At this point, additional radio-opaque or other contrast dye is injected, and the distal seal is assessed. If there are leaks, the distal variable sealing device is again activated to expand the diameter of the distal circumferential sealable collar for a firmer contact. The seal is reassessed and adjusted until there no contrast dye leaks are seen. At this point, the operator may remove the injector cannula and detach the control leads from the variable sealing devices, and remove the control leads and guide wires from their arteriotomy sites and close the wounds.
• The preceding description is presented only as an exemplary application of the devices and methods according to the present invention.
BRIEF DESCRIPTION OF THE DRAWINGS
• FIG. 1A is a side perspective view of the proximal tip of a delivery catheter containing a disclosed embodiment of the present invention of a compressed or folded bifurcated endovascular implant with a contralateral cuff housed within a sheath.
• FIG. 1B is a side perspective view of the proximal tip of a delivery catheter containing a disclosed embodiment of the present invention of a decompressed or unfolded endovascular implant removed from a sheath.
• FIG. 2A is a side perspective view of the proximal tip of a delivery catheter containing a disclosed embodiment of the present invention of a compressed or folded endograft segmental implant housed within a sheath of the present invention.
• FIG. 2B is a side perspective view of the proximal tip of a delivery catheter containing a disclosed embodiment of the present invention of a decompressed or unfolded endograft segmental implant removed from a sheath of the present invention.
• FIG. 3 is a side perspective view of a disclosed embodiment of the present invention of an endograft segmental implant.
• FIG. 4 is a perspective anatomic view of a disclosed embodiment of the present invention in which the proximal tip of an implant delivery catheter placed in a first side through a femoral artery is positioned in an abdominal aorta in an infrarenal location, but above the origin of an abdominal aortic aneurysm.
• FIG. 5 is a perspective anatomic view of the disclosed embodiment of the present invention ofFIG. 4 in which an injector cannula has been introduced through a lumen of the implant delivery catheter, and protrudes proximal to the tip of the implant delivery catheter to fully expose all injector ports for radio-opaque contrast dye injection therethrough.
• FIG. 6 is a perspective anatomic view of the disclosed embodiment of the present invention ofFIG. 5 in which the sheath of the implant delivery catheter has been retracted or partially opened to allow the endograft implant therein to partially decompress or unfold, to expose the proximal elastic implant end and a length of the non-elastic tubular body.
• FIG. 7 is a perspective anatomic view of the disclosed embodiment of the present invention ofFIG. 6 in which the implant delivery catheter has been slightly withdrawn under radiographic control to position the proximal tip of the implant distal to the origins of the renal arteries to preserve flow therein.
• FIG. 8 is a perspective anatomic view of the disclosed embodiment of the present invention ofFIG. 7 in which operator action on one or more control leads connected to one or more variable sealing devices has caused the extended circumferential sealable collar of the implant's elastic proximal end to firmly and fully contact the inner wall of the aorta, effecting a vascular seal therein.
• FIG. 9 is a perspective anatomic view of the disclosed embodiment of the present invention ofFIG. 8 in which operator action has fully retracted or opened and removed the sheath of the implant delivery catheter allowing the endograft implant therein to fully decompress or unfold, to expose a distal elastic implant end and a non-elastic contralateral cuff.
• FIG. 10 is a perspective anatomic view of the disclosed embodiment of the present invention ofFIG. 9 in which operator action on one or more control leads connected to one or more variable sealing devices has caused the extended circumferential sealable collar of the implant's elastic distal end to firmly and fully contact the inner wall of the common iliac artery above the origin of the internal iliac artery, effecting a vascular seal therein and preserving flow through the internal iliac artery.
• FIG. 11 is a perspective anatomic view of the disclosed embodiment of the present invention ofFIG. 10 in which operator action has placed a hooked second guide wire to grasp and stabilize the non-elastic contralateral cuff under radiographic visualization through an access via a second side through a femoral artery.
• FIG. 12 is a perspective anatomic view of the disclosed embodiment of the present invention ofFIG. 11 in which operator action has placed a contralateral delivery catheter over the second guide wire.
• FIG. 13 is a perspective anatomic view of the disclosed embodiment of the present invention ofFIG. 12 in which operator action has removed the sheath of the contralateral delivery catheter allowing the endograft segmental implant therein to fully decompress or unfold, to expose a proximal segmental elastic implant end, a distal segmental elastic implant end, and the full length of the non-elastic segmental tubular implant body connecting said ends.
• FIG. 14 is a perspective anatomic view of the disclosed embodiment of the present invention ofFIG. 13 in which operator action on one or more control leads connected to one or more variable sealing devices has caused the extended circumferential sealable collar of the implant's proximal segmental elastic implant end to expand to firmly and fully contact the inner walls of the non-elastic contralateral cuff effecting a proximal seal, and then similarly caused the extended circumferential sealable collar of the implant's distal segmental elastic implant end to expand to firmly and fully contact the inner wall of the common iliac artery on the second side above the origin of the internal iliac artery, effecting a vascular seal therein and preserving flow through the internal iliac artery.
• FIG. 15 shows an diagrammatic view of a patient in a dorsal supine position, with a disclosed embodiment of an endovascular implant according to the present invention in sealed position in the patient's abdominal aorta proximally and distally, and with arteriotomy incisions in both femoral arteries with an injector cannula and proximal and distal control leads in place in the patient's right arteriotomy site for radiographic contrast dye injection and a second guide wire in place in the patient's left arteriotomy site, corresponding to the procedural stage shown inFIG. 11.
• FIG. 16 is a longitudinal anatomic view showing a disclosed embodiment of a thoracic endovascular implant according to the present invention in sealed position proximally and distally in a patient's descending thoracic aorta.
• FIG. 17 is a longitudinal anatomic view showing an alternate disclosed embodiment of a thoracic endovascular implant in a patient's descending thoracic aorta according to the present invention in which a first thoracic endovascular implant with a non-elastic distal cuff has been sealed in position proximally and distally has been joined by a second thoracic endovascular implant with a non-elastic tubular body with an elastic proximal end and an elastic distal end, both containing circumferential sealable collars and variable sealing devices capable of achieving a desired seal between the collar and the vessel's inner wall.
• FIG. 18A is a side perspective view of the disclosed embodiment of an endovascular implant according to the present invention in which the proximal and distal circumferential sealable collars are provided with retractable retention tines and shown in a retracted, pre-deployment position.
• FIG. 18B is a cross-sectional view of a disclosed embodiment according to the present invention of a proximal or distal circumferential sealable implant collar with retention tines covered by a compressible foam sheathing in a retracted, pre-deployment position.
• FIG. 19A is a longitudinal anatomic view of a disclosed embodiment according to the present invention of an endovascular implant which is being deployed and sealed proximally in an abdominal aorta containing an infrarenal aneurysm, with incomplete distal circumferential sealable implant collar expansion and seal at this stage of the procedure.
• FIG. 19B is a cross-sectional view of the distal circumferential sealable implant collar inFIG. 19A, showing the compressible foam sheathing covering the collar's retention tines within a vessel's lumen.
• FIG. 20A is a longitudinal anatomic view of a disclosed embodiment according to the present invention of an endovascular implant which is being deployed and sealed proximally in an abdominal aorta containing an infrarenal aneurysm, with complete proximal circumferential sealable implant collar expansion and seal at this stage of the procedure.
• FIG. 20B is a cross-sectional view of the proximal circumferential sealable implant collar inFIG. 20A, showing compression of the compressible foam sheathing allowing the collar's retention tines to contact and engage the aortic wall circumferentially.
• FIG. 21A is a perspective view of an embodiment of a variable sealing device according to the present invention.
• FIG. 21B is a sectional view of an embodiment of a variable sealing device according to the present invention, in which the mechanism is in a released, locked state.
• FIG. 21C is a sectional view of an embodiment of a variable sealing device according to the present invention, in which the mechanism is in an engaged, unlocked state.
• FIG. 21D is a perspective view of an embodiment of a sealable collar containing a variable sealing device according to the present invention.
• FIG. 22A is a longitudinal anatomic view of a disclosed embodiment according to the present invention of an endovascular implant incorporating an endograft monitoring device attached to the aneurysmal sac wall and the outer wall of the endograft in which the endograft has been effectively sealed in position proximally and distally to an aneurysm, thus devascularizing the aneurysmal sac to allow the walls of the aneurysm to collapse against the endograft, and hold the endograft monitoring device in a collapsed position.
• FIG. 22B is a longitudinal anatomic view of a disclosed embodiment according to the present invention of an endovascular implant incorporating an endograft monitoring device ofFIG. 22A in which the aneurysmal sac has become revascularized, allowing the endograft monitoring device to spring open such that it may be visualized on x-ray or other diagnostic visualization means.
• FIG. 22C shows an alternate embodiment of an endovascular implant incorporating an endograft monitoring device according to the present invention, in which said endograft monitoring device comprises more than one spring-like attachment to both the outer wall of the endograft and to the inner wall of the aneurysmal sac, and in which the aneurysmal sac has been sealed and devascularized, allowing the walls of the aneurysm to collapse against the endograft, and hold the endograft monitoring device in a collapsed position.
• FIG. 22D shows the alternate embodiment of an endovascular implant incorporating an endograft monitoring device according to the present invention ofFIG. 22C, in which said endograft monitoring device comprises more than one spring-like attachment to both the outer wall of the endograft and to the inner wall of the aneurysmal sac, and in which the aneurysmal sac has become revascularized, allowing the endograft monitoring device to spring open such that it may be visualized on x-ray or other diagnostic visualization means.
• FIG. 22E shows yet another an alternate embodiment of an endovascular implant incorporating an endograft monitoring device according to the present invention, in which said endograft monitoring device comprises a plurality of spring-like attachment to both the outer wall of the endograft and to the inner wall of the aneurysmal sac, and in which the aneurysmal sac has been sealed and devascularized, allowing the walls of the aneurysm to collapse against the endograft, and hold the endograft monitoring device in a collapsed position.
• FIG. 22F shows the embodiment of an endovascular implant incorporating an endograft monitoring device according to the present invention ofFIG. 22E, in which said endograft monitoring device comprises more than one spring-like attachment to both the outer wall of the endograft and to the inner wall of the aneurysmal sac, and in which the aneurysmal sac has become revascularized, allowing the endograft monitoring device to spring open such that it may be visualized on x-ray or other diagnostic visualization means.
DETAILED DESCRIPTION OF INVENTION
• The present invention may be understood more readily by reference to the following detailed description of the preferred embodiments of the invention and the examples included herein. However, before the preferred embodiments of the devices and methods according to the present invention are disclosed and described, it is to be understood that this invention is not limited to the exemplary embodiments described within this disclosure, and the numerous modifications and variations therein that will be apparent to those skilled in the art remain within the scope of the invention disclosed herein. It is also to be understood that the terminology used herein is for the purpose of describing specific embodiments only and is not intended to be limiting.
• Unless otherwise noted, the terms used herein are to be understood according to conventional usage by those of ordinary skill in the relevant art. In addition to the definitions of terms provided below, it is to be understood that as used in the specification and in the claims, “a” or “an” can mean one or more, depending upon the context in which it is used.
• The present invention is directed towards novel designs for sealable and repositionable endovascular implant grafts, and methods for their use for the treatment of aortic aneurysms and other structural vascular defects.
• In an exemplary embodiment according to the present invention, a sealable vascular endograft system for placement in a vascular defect is provided, comprising an elongated main implant delivery catheter with an external end and an internal end for placement in a blood vessel with internal walls. In such an exemplary embodiment, the main implant delivery catheter further comprises a main implant delivery catheter sheath which may be openable or removable at said internal end and a main implant delivery catheter lumen containing within a compressed or folded endovascular implant. Further in such an exemplary embodiment, an endovascular implant comprises a non-elastic tubular implant body with an elastic proximal end terminating in a proximal sealable circumferential collar controlled by a proximal variable sealing device which is operated by a proximal control lead that traverses said main implant delivery catheter and exits at said external end for interface by an operator, such that said proximal sealable circumferential collar may be expanded or contracted by said operator to achieve a fluid-tight seal between said proximal sealable circumferential collar and the internal walls of said blood vessel proximal to said vascular defect. Moreover, in such an exemplary embodiment, an endovascular implant further comprises a non-elastic tubular implant body with an elastic distal end terminating in a distal sealable circumferential collar controlled by a distal variable sealing device which is operated by a distal control lead that exits said main implant delivery catheter at said external end for interface by an operator, such that said distal sealable circumferential collar may be expanded or contracted by said operator to achieve a fluid-tight seal between said distal sealable circumferential collar and the internal walls of said blood vessel distal to the vascular defect.
• Referring now in more detail to the drawings, in which like numerals indicate like elements throughout the several views,FIG. 1A shows a side perspective view of the proximal tip of a mainimplant delivery catheter100 with a main implantdelivery catheter lumen102 containing a disclosed embodiment of compressed or foldedendovascular implant200 housed within a main implantdelivery catheter sheath104. Theendovascular implant200 in the embodiment shown inFIG. 1A includes a non-elastictubular implant body106 with an elasticproximal end108 and an elasticdistal end110. The elasticproximal end108 terminates in a proximal sealablecircumferential collar112, controlled by a proximalvariable sealing device116 which is operated by aproximal control lead120 that traverses the mainimplant delivery catheter100 and exits distally for interface with an operator (not shown inFIG. 1A). The elasticdistal end110 terminates in a distal sealablecircumferential collar114, controlled by a distalvariable sealing device118 which is operated by adistal control lead122 that exits the mainimplant delivery catheter100 distally for interface with an operator (not shown inFIG. 1A).
• The embodiment of anendovascular implant200 ofFIG. 1A is further shown inFIG. 1B removed from the mainimplant delivery catheter100 and in a semi- or partially expanded or non-folded state. In addition to the elements described inFIG. 1A, theendovascular implant200 in the embodiment shown inFIG. 1B may also include a contralateralnon-elastic cuff126.
• An alternate embodiment of a sealable endovascular implant according to the present invention is shown inFIG. 2A. The proximal tip of a mainimplant delivery catheter100 with a main implantdelivery catheter lumen102 containing a disclosed embodiment of compressed or folded straightendovascular implant202 housed within a main implantdelivery catheter sheath104. Theendovascular implant202 in the embodiment shown inFIG. 2A includes a non-elastictubular implant body106 with an elasticproximal end108 and an elasticdistal end110. The elasticproximal end108 terminates in a proximal sealablecircumferential collar112, controlled by a proximalvariable sealing device116 which is operated by aproximal control lead120 that traverses the mainimplant delivery catheter100 and exits distally for interface with an operator (not shown inFIG. 2A). The elasticdistal end110 terminates in a distal sealablecircumferential collar114, controlled by a distalvariable sealing device118 which is operated by adistal control lead122 that exits the mainimplant delivery catheter100 distally for interface with an operator (not shown inFIG. 2A).
• The embodiment of anendovascular implant202 ofFIG. 2A is further shown inFIG. 2B removed from the mainimplant delivery catheter100 and in an semi- or partially expanded or non-folded state. A straightendovascular implant202 according to the embodiment shown inFIGS. 2A and 2B provides a non-branching conduit between the proximal sealablecircumferential collar112 and the distal sealablecircumferential collar114.
• An embodiment of an endograft segmental implant according to the present invention is shown inFIG. 3. An endograftsegmental implant306 sealably interfaces to provide a conduit between a non-elastic vascular graft and a distal blood vessel. As shown inFIG. 3, an endograftsegmental implant306 includes a non-elastic tubularsegmental implant body308 with an elastic proximalsegmental end310 and an elastic distalsegmental end312. The elastic proximalsegmental end310 terminates in a proximal segmental sealablecircumferential collar314, controlled by a proximal segmentalvariable sealing device318 which is operated by a proximalsegmental control lead322 that traverses a segmental implant delivery catheter (not shown inFIG. 3) and exits distally for interface with an operator (not shown inFIG. 3). The elastic distalsegmental end312 terminates in a distal sealable segmentalcircumferential collar316, controlled by a distal segmentalvariable sealing device320 which is operated by a distalsegmental control lead324 that exits a segmental implant delivery catheter distally for interface with an operator (not shown inFIG. 3).
• In various embodiments according to the present invention,endovascular implants200 may be constructed of solid, woven, non-woven, or mesh materials such as, but not limited to, natural or synthetic rubbers, nylon, Goretex, elastomers, polyisoprenes, polyphosphazenes, polyurethanes, vinyl plastisols, acrylic polyesters, polyvinylpyrrolidone-polyurethane interpolymers, butadiene rubbers, styrene-butadiene rubbers, rubber lattices, Dacron, PTFE, malleable metals, other biologically compatible materials or a combination of such biologically compatible materials in a molded, woven, or non-woven configuration, coated, non-coated, and other polymers or materials with suitable resilience and pliability qualities. In certain preferred embodiments according to the present invention, it is desirable for the non-elastictubular implant body106 and corresponding structures to be pliable to allow for folding or compressibility without allowing elasticity. In certain preferred embodiments according to the present invention, it is desirable for the elasticproximal end108 and the elasticdistal end110 and corresponding structures to be both elastic and compressible or foldable. In any given preferred embodiment, the non-elastictubular implant body106, the elasticproximal end108, the elasticdistal end110 and corresponding structures may be constructed of the same material of varying elasticity, or these structures may be constructed of different, but compatible materials.
• FIGS. 4-9 illustrate an exemplary embodiment of sealable endovascular implants and an illustrative method of their use according to the present invention for the treatment of an infrarenal abdominal aortic aneurysm with vascular access through bilateral femoral arteriotomy sites.
• InFIG. 4 a mainimplant delivery catheter100 has been placed in a first side through a femoral artery (not shown inFIG. 4) and positioned in anabdominal aorta402 in a location distal to therenal arteries408, but above the origin of an abdominalaortic aneurysm410.
• FIG. 5 is a continuation of the disclosed embodiment of the present invention ofFIG. 4 in which aninjector cannula404 with one ormore injection ports406 has been introduced through a mainimplant delivery lumen102 of the mainimplant delivery catheter100, and protrudes proximal to the tip of theimplant delivery catheter100 to fully expose theinjector ports406 for real-time visualization contrast dye injection therethrough. Such contrast dye injection may be performed using radio-opaque or other contrast dyes for fluoroscopy, computerized tomography, or other radiographic techniques. In alternate embodiments according to the present invention, other real-time visualization techniques may be used, including but not limited to, ultrasound or nuclear magnetic resonance techniques using appropriate contrast dye materials for injection. Such contrast dye injection allows an operator to assess the distance between the origins of therenal arteries408, and the origin of the aorticaneurysmal sac410 for proper implant placement.
• FIG. 6 is a continuation of the disclosed embodiment of the present invention ofFIG. 5 in which the main implantdelivery catheter sheath104 of the mainimplant delivery catheter100 has been retracted or partially opened to allow theendovascular implant200 therein to partially open or unfold from its initially compressed or folded position. Additional contrast dye injection through theinjector cannula404 may be performed by the operator at this point to verify the level of the proximal circumferentialsealable collar112 with respect to the level of therenal arteries408.FIG. 7 is a continuation of the disclosed embodiment of the present invention ofFIG. 6 in which the level of the proximal circumferentialsealable collar112 has been adjusted by the operator with respect to the level of therenal arteries408 for optimal deployment.
• FIG. 8 is a continuation of the disclosed embodiment of the present invention ofFIG. 7 in which operator action on one or more proximal control leads120 connected to one or more proximalvariable sealing devices116 has caused the proximal circumferentialsealable collar112 of the elasticproximal end108 of theendovascular implant200 to firmly and fully contact the aorticinner wall124, effecting a vascular seal therein.
• FIG. 9 is a continuation of the disclosed embodiment of the present invention ofFIG. 8 in which operator action has fully retracted or opened and removed the mainimplant delivery sheath104 of the mainimplant delivery catheter100 allowing theendovascular implant200 therein to fully decompress or unfold, thus exposing a distalelastic implant end110 and a non-elasticcontralateral cuff126. At this point in a deployment procedure, additional contrast dye injection would likely again be performed to ascertain that there is a complete seal at the level of the proximal circumferentialsealable collar112. If leakage is still visualized, additional operator action on the proximal control lead (s)120 may be used to further expand the proximal circumferentialsealable collar112 to secure an acceptable seal. Alternately, operator action may reduce the expanded proximal circumferentialsealable collar112 to allow its reposition and redeployment, again under real-time radiographic or other visualized control.
• FIG. 10 is a continuation of the disclosed embodiment of the present invention ofFIG. 9 once a suitable proximal seal has been achieved. Operator action on one or more distal control leads122 connected to one or more distalvariable sealing devices118 has caused the extended distal circumferentialsealable collar114 of the endovascular implant's200 elasticdistal end110 to firmly and fully contact the inner wall of the commoniliac artery412 above the origin of the internaliliac artery414, effecting a vascular seal therein and preserving flow through the internaliliac artery414. Additional contrast dye injection through theinjector cannula404 would be used by the operator to confirm adequate seals both proximally and distally at this point.
• FIG. 11 is a continuation of the disclosed embodiment of the present invention ofFIG. 10 in which operator action has placed asecond guide wire302 provided with anengagement tip328 to grasp and stabilize the non-elasticcontralateral cuff126 under radiographic or other imaging control through an access via a second side through a femoral arteriotomy (not shown inFIG. 11).
• FIG. 12 is a continuation of the disclosed embodiment of the present invention ofFIG. 11 in which operator action has placed acontralateral delivery catheter300 over thesecond guide wire302. Thecontralateral delivery catheter300 includes a contralateraldelivery catheter lumen304 and a contralateral delivery catheter sheath340 which may be operably opened or retracted by operator action.
• FIG. 13 is a continuation of the disclosed embodiment of the present invention ofFIG. 12 in which operator action has removed the contralateral delivery catheter sheath340 of thecontralateral delivery catheter300 allowing the endograftsegmental implant344 therein to fully decompress or unfold to expose a proximal segmentalelastic implant end348, a distal segmentalelastic implant end356, and the full length of a non-elastic segmentaltubular implant body346 connecting said ends348 and356.
• FIG. 14 is a continuation of the disclosed embodiment of the present invention ofFIG. 13 in which operator action on one or more proximal segmental control leads354 connected to one or more proximal segmentalvariable sealing devices352 has caused the expansion of proximal segmental circumferentialsealable collar350 of the endograft segmental implant's344 elastic proximalsegmental implant end348 to firmly and fully contact the inner walls of the non-elasticcontralateral cuff126 effecting a proximal seal, and then similarly caused the distal segmental circumferentialsealable collar358 of the endograft segmental implant's344 elastic distalsegmental implant end356 to expand to firmly and fully contact the inner wall of the commoniliac artery416 on the second side above the origin of the internaliliac artery418, effecting a vascular seal therein and preserving flow through the internaliliac artery418. Once sealed, the aorticaneurysmal sac410 is devascularized and collapses.
• FIG. 15 shows an diagrammatic view of apatient500 in a dorsal supine position, with a disclosed embodiment of anendovascular implant200 according to the present invention in sealed position in the patient'sabdominal aorta402 proximally and distally, and witharteriotomy incisions332,336 in both femoral arteries with aninjector cannula330 for radiographic contrast dye injection and proximal120 and distal122 control leads for operator manipulation in place in the patient'sright arteriotomy site332 and asecond guide wire302 in place in the patient'sleft arteriotomy site336, corresponding to the procedural stage shown inFIG. 11.
• FIG. 16 shows an anatomic view of a disclosed embodiment of a thoracicendovascular implant600 according to the present invention in sealed position proximally and distally in a patient's descendingthoracic aorta612, traversing a devascularized thoracicaortic aneurysm614. In a patient, the ascendingaorta604 arises from theheart602 and gives rise to theinnominate artery606, the left commoncarotid artery608, and the leftsubclavian artery610 before continuing as the descendingthoracic aorta612. The thoracicendovascular implant600 includes a non-elastic tubularthoracic implant body616 with an elastic proximalthoracic end618 and an elastic distalthoracic end626. The elastic proximalthoracic end618 terminates in a proximal thoracic sealablecircumferential collar620, controlled by a proximal thoracicvariable sealing device622 which is operated by a proximalthoracic control lead624 that traverses a thoracic implant delivery catheter (not shown inFIG. 16) and exits distally for interface with an operator (not shown inFIG. 16). The elastic distalthoracic end626 terminates in a distal sealable thoraciccircumferential collar628, controlled by a distal thoracicvariable sealing device630 which is operated by a distalthoracic control lead632 that exits a thoracic implant delivery catheter distally for interface with an operator (not shown inFIG. 6).
• FIG. 17 provides an anatomic view showing an alternate disclosed embodiment of a thoracicendovascular implant700 in a patient's descendingthoracic aorta612 according to the present invention in which a first thoracicendovascular implant718 includes a non-elasticdistal cuff730, a proximal first thoracic circumferentialsealable collar724, a proximal first thoracicvariable sealing device726, and a proximal firstthoracic control lead728. As shown inFIG. 17, the first thoracicendovascular implant718 has been sealed in position proximally by operator action on the proximal first thoracicvariable sealing device726 using the proximal firstthoracic control lead728, expanding the proximal first thoracic circumferentialsealable collar724 to achieve a proximal seal within the descendingthoracic aorta612, and effectively devascularizing athoracic aneurysm614 therein.
• As further shown inFIG. 17, the first thoracicendovascular implant718 has been joined distally by a second thoracicendovascular implant732, which includes an elastic proximal secondthoracic implant end736, a non-elastic tubular secondthoracic implant body734, and an elastic distal secondthoracic implant end746. The elastic proximal secondthoracic implant end736 includes a proximal second thoracic circumferentialsealable collar738, a proximal second thoracic variable sealing device740, and a proximal secondthoracic control lead742, and the elastic distal secondthoracic implant end746 includes a distal second thoracic circumferential sealable collar748, a distal second thoracicvariable sealing device750, and a distal secondthoracic control lead752.
• In an exemplary application according to the present invention as shown inFIG. 17, an operator would first secure a seal in the proximal descending thoracic aorta using the first thoracicendovascular implant718, and then seal the proximal and distal aspects, respectively, of the second thoracicendovascular implant732, using real-time radiographic or other visualization techniques with injected contrast dye as previously described in this disclosure.
• FIGS. 18A and 18B show an embodiment of an endovascular implant according to the present invention similar to the disclosure ofFIG. 1B, with the additional inclusion of one ofmore retention tines136 attached to the proximal circumferentialsealable collar112 and distal circumferentialsealable collar114.
• In a preferred embodiment according to the present invention, a plurality ofretention tines136 is used. In a preferred embodiment according to the present invention, theretention tines136 are oriented to extend radially outward from the proximal circumferentialsealable collar112 and distal circumferentialsealable collar114. In various preferred embodiment according to the present invention, theretention tines136 may be oriented to extend perpendicularly or at any other desired angle outward from the proximal circumferentialsealable collar112 and distal circumferentialsealable collar114.
• In various preferred embodiment according to the present invention, theretention tines136 may be constructed of any biocompatible material including, but not limited to, metals, plastics, or ceramics.
• As further shown inFIG. 18B theretention tines136 of the proximal circumferentialsealable collar112 and distal circumferentialsealable collar114 covered by acompressible foam sheathing134 in a pre-deployment position. In various preferred embodiment according to the present invention, thecompressible foam sheathing134 may be constructed of any biocompatible material of suitable compressibility to allow the foam to be substantially compressed by the pressure of the proximal circumferentialsealable collar112 and distal circumferentialsealable collar114 against the inner wall of a target artery, upon operator deployment. Thecompressible foam sheathing134 may also be constructed of material of suitable memory characteristics to allow the foam to substantially decompress to its pre-deployment position, covering theretention tines136, if pressure against the arterial wall is removed, thus allowing repositioning or removal of an endovascular implant according to the present invention at the operator's discretion.
• Compressible foam sheathing134 may be any biocompatible foam material of either an open or closed cell structure with sufficient compressibility and resilience to allow rapid recovery in a non-compressed state. In various preferred embodiments according to the present invention, such foam materials may be viscoelastic foam with a compressible cellular material that has both elastic (spring-like) and viscous (time-dependent) properties. Viscoelastic foam differs from regular foam by having time-dependent behaviors such as creep, stress relaxation, and hysteresis.
• FIGS. 19A and 19B show the exemplary endovascular implant ofFIGS. 18A and 18B in the anatomic context of anendovascular implant100 being deployed and sealed proximally in anabdominal aorta402 containing ananeurysm410, with complete expansion and seal at the level of the proximal circumferentialsealable implant collar112 against the aorticinner wall124, but incomplete expansion and no seal against the arterialinner wall144 at the level of the distal circumferentialsealable implant collar114 at this stage of the procedure. As shown in the cross-sectional view ofFIG. 19B, theretention tines136 of the proximal circumferentialsealable collar112 and distal circumferentialsealable collar114 covered by acompressible foam sheathing134 in a pre-deployment position.
• FIGS. 20A and 20B further show the exemplary endovascular implant ofFIGS. 18A and 18B in the anatomic context of anendovascular implant100 being deployed and sealed proximally in anabdominal aorta402 containing ananeurysm410, now with complete expansion of the distal circumferentialsealable implant collar114 and complete seal against the arterialinner wall144 at this stage of the procedure. As shown in the cross-sectional view ofFIG. 19B,compressible foam sheathing134 is compressed between the distal circumferentialsealable collar114 and the arterialinner wall144, allowing theretention tines136 to engage the arterialinner wall144 in their deployed position, thereby serving to retain the deployed position of theendovascular implant100.
• In given various preferred embodiments according to the present invention,retention tines136 and thecompressible foam sheathing134 as described above may be used in conjunction with any or all circumferentially sealable elements in this disclosure, including but not limited to, proximal circumferentialsealable collars112, distal circumferentialsealable collars114, proximal segmental circumferentialsealable collars314, distal segmental circumferentialsealable collars316, proximal thoracic circumferentialsealable collars620, distal thoracic circumferentialsealable collars628, proximal first thoracic circumferentialsealable collars724, proximal second thoracic circumferentialsealable collars738, and distal second thoracic circumferential sealable collars748.
• FIGS. 21 A-D illustrate details of an embodiment of a variable sealing device according to the present invention. A variablesealing mechanism assembly2100 comprises asealing device housing2102 attached to asealer belt2104 with a sealer belt fixedend2108 attached to saidhousing2102 and with a sealer beltmoveable end2110 operably passing through said housing and collecting in a concentricbelt receiver channel2130 as said sealer beltmoveable end2110 exits saidhousing2102. The sealer beltmoveable end2110 contains a plurality of uniformly distributedbelt engagement slots2106. Thebelt engagement slots2106 may be round, oval, square, rectangular, triangular, or any other shape, but are sized, spaced, and configured on said sealer beltmoveable end2110 to engage withsealer gear teeth2116 of asealer gear2114 rotatably located within ahousing gear recess2112 contained within saidhousing2102. Thesealer gear teeth2116 are oriented to present on the outer circumference of saidsealer gear2114. On the inner circumference of saidsealer gear2114, a plurality of uniformly distributed sealergear retainment slots2118 are configured to receive a lockingmember2120. The lockingmember2120, in various embodiments according to the present invention may be a simple strip or bar as shown inFIGS. 21 A-D, or it may be triangular, cross-shaped, stellate or other geometric shapes that would allow the sealergear retainment slots2118 to receive the ends of said lockingmember2120. The lockingmember2120 is fabricated of a metal or plastic with resilient spring, like properties, such that, when depressed or pulled in a perpendicular vector with respect to thesealer gear2114, the ends of said lockingmember2120 are withdrawn from the sealergear retainment slots2118, thus allowing thesealer gear2114 to rotate within saidhousing gear recess2112, as shown inFIGS. 21 B and C.The locking member2120 is further provided with one or more sealer gear drive pins2126, which are received by gear drive pins2126 saidsealer gear2114 when the lockingmember2120 is depressed, as shown inFIG. 21C. In various preferred embodiments according to the present invention, the gear drive pins2126 and gear drive pins2126 may be tapered, straight, or otherwise shaped to facilitate their secure engagement and release. The lockingmember2120 is depressed by action of acontrol lead shaft2124, which is removably attached to the lockingmember2120 at acontrol lead attachment2122. In an exemplary embodiment of the present invention, as shown inFIG. 21C, while the lockingmember2120 is released from the sealergear retainment slots2106 by a depressing action of thecontrol lead shaft2124, rotation of thecontrol lead shaft2124 will permit the sealer gear drive pins2126 to transmit a rotational force to thesealer gear2114, engaging thebelt engagement slots2106 in the movable end of thesealer belt2110, and causing the movable end of thesealer belt2110 to move in or out of the concentricbelt receiver channel2130. This motion has the effect of increasing or decreasing the surface area of thesealer belt2104.
• FIG. 21D shows an exemplary embodiment according to the present invention, in which asealable collar2140 contains a variablesealing mechanism assembly2100 comprising asealing device housing2102 attached to asealer belt2104 with a sealer belt fixedend2108 attached to saidhousing2102 and with a sealer beltmoveable end2110 operably passing through said housing and collecting in a concentricbelt receiver channel2130 as said sealer beltmoveable end2110 exits saidhousing2102. Thesealable collar2140 is constructed of a tubular elastic body in a closed loop defining acentral collar lumen2142. Thesealer belt2104 may pass circumferentially through substantially all of thesealable collar2140, as shown inFIG. 21D, but in alternate embodiments may pass through only some of the circumference of thesealable collar2140. As the variablesealing mechanism assembly2100 is operated, the length of thesealer belt2104 may enlarge or constrict, with similar action on thesealable collar2140, thus allowing a variable seal to be achieved between thesealable collar2140 and the inner lumen of a vessel wall (not shown inFIG. 21D) containing thesealable collar2140.
• Within certain embodiments of the present invention, an endograft may also incorporate radio-opaque, echogenic materials and magnetic resonance imaging (MRI) responsive materials (i.e., MRI contrast agents) to aid in visualization of the device under x-ray, ultrasound, fluoroscopy MRI or other imaging modalities. In addition, various embodiments according to the present invention may incorporate markers comprising various radio-opaque, echogenic materials and magnetic resonance imaging (MRI) responsive materials that may be placed on the walls of an aneurysm sac or on other anatomic sites for improved postoperative visualization to monitor for aneurysmal revascularization.
• As shown inFIGS. 22A-22F, various embodiments according to the present invention may also be provided with one or more endograft monitoring devices to facilitate diagnosis of postoperative graft failure and aneurysm revascularization. In some embodiments according to the present invention, endograft monitoring devices may be pressure sensors positioned to demonstrate positive pressure within the former aneurysmal sac in some manner that may be identifiable by electronic, radiographic, or other visual or electronic communications.FIGS. 22A-F illustrate yet other embodiments of endograft monitoring devices according to the present invention.
• FIGS. 22A-22B show an embodiment of a sealablevascular endograft system2200 which incorporates an endograft monitoring device comprising an radio-opaquegraft attachment member2205 joined at amonitoring pivot2210 to a radio-opaque aneurysmal attachment2220 which is affixed by an operator at the time of endograft placement to the inner wall of theaneurysmal sac2215, which is shown in a collapsed, nonvascularized state inFIG. 22A, but in an expanded, revascularized state inFIG. 22B. As further shown inFIG. 22B, the expansion of theaneurysmal sac2215, has the further effect of increasing the angle between the radio-opaquegraft attachment member2205 and the radio-opaque aneurysmal attachment2220. In such an embodiment, plain radiographs or other visualization means could be employed to evaluate the angle between the attachment members of an endograft monitoring device to detect endograft failure and revascularization of the aneurysm without requiring more invasive and expensive diagnostic studies.
• FIGS. 22C and 22D illustrate yet another embodiment of an embodiment of a sealablevascular endograft system2200 which incorporates an endograft monitoring device comprising an radio-opaque graft attachment2202 pivotably joined by two or more radio-opaquegraft frame members2212 which are in turn joinedframe pivots2204 to radio-opaqueaneurysmal frame members2214 which are joined at ananeurysmal attachment2216 which is affixed by an operator at the time of endograft placement to the inner wall of theaneurysmal sac2215, which is shown in a collapsed, nonvascularized state inFIG. 22C, but in an expanded, revascularized state inFIG. 22D. As further shown inFIG. 22D, the expansion of theaneurysmal sac2215, has the further effect of increasing the angles between the radio-opaquegraft frame member2212 and the radio-opaqueaneurysmal frame members2214 to create a square or polygonal shape visible on radiographs. In such an embodiment, plain radiographs or other visualization means could again be employed to evaluate the angles between the attachment members of an endograft monitoring device to detect endograft failure and revascularization of the aneurysm without requiring more invasive and expensive diagnostic studies.
• FIGS. 22E and 22F illustrate still another embodiment of an embodiment of a sealablevascular endograft system2200 which incorporates an endograft monitoring device comprising two or more radio-opaque graft attachment2202 pivotably joined by two or more radio-opaquegraft frame members2212 which are in turn joinedframe pivots2204 to radio-opaqueaneurysmal frame members2214 which are joined at two or moreaneurysmal attachments2216 which are affixed by an operator at the time of endograft placement to the inner wall of theaneurysmal sac2215, which is shown in a collapsed, nonvascularized state inFIG. 22E, but in an expanded, revascularized state inFIG. 22F. As further shown inFIG. 22F, the expansion of theaneurysmal sac2215, has the further effect of increasing the angles between the radio-opaquegraft frame member2212 and the radio-opaqueaneurysmal frame members2214 to create a square or polygonal shape visible on radiographs. In such an embodiment, three-dimensional, cage-like structures could be formed by the various frame members described, further enhancing the clinical visibility of an indication of aneurysmal revascularization.
• Although the foregoing embodiments of the present invention have been described in some detail by way of illustration and example for purposes of clarity and understanding, it will be apparent to those skilled in the art that certain changes and modifications may be practiced within the spirit and scope of the present invention. Therefore, the description and examples presented herein should not be construed to limit the scope of the present invention, the essential features of which are set forth in the appended claims.

Claims (15)

1. A sealable vascular endograft system for placement in a vascular defect, comprising:

an elongated main implant delivery catheter with an external end and an internal end for placement into a blood vessel with internal walls, said main implant delivery catheter further comprising:

a main implant delivery catheter sheath which may be openable or removable at said internal end;

a main implant delivery catheter lumen containing within a compressed or folded endovascular implant;

said endovascular implant further comprising:

a non-elastic tubular implant body with an elastic proximal end and an elastic distal end, said elastic proximal end terminating in a proximal sealable circumferential collar controlled by a proximal variable sealing device which is operated by a proximal control lead that traverses said main implant delivery catheter and exits at said external end for interface by an operator, such that said proximal sealable circumferential collar may be expanded or contracted by said operator to achieve a fluid-tight seal; between said proximal sealable circumferential collar and the internal walls of said blood vessel proximal to said vascular defect;

said elastic distal end terminating in a distal sealable circumferential collar controlled by a distal variable sealing device which is operated by a distal control lead that exits said main implant delivery catheter at said external end for interface by said operator, such that said distal sealable circumferential collar may be expanded or contracted by said operator to achieve a fluid-tight seal between said distal sealable circumferential collar and the internal walls of said blood vessel distal to said vascular defect.

2. An endovascular implant comprising:

a tubular implant body with a proximal end and a distal end,

said proximal end terminating in a proximal sealable circumferential collar controlled by a proximal variable sealing device which is operated by an operator, such that said proximal and distal sealable circumferential collar may be expanded or contracted by said operator to achieve a fluid-tight seal between said proximal sealable circumferential collar and the internal walls of said blood vessel proximal to said vascular defect;

and said elastic distal end terminating in a distal sealable circumferential collar controlled by a distal variable sealing device which is operated by said operator, such that said distal sealable circumferential collar may be expanded or contracted by said operator to achieve a fluid-tight seal between said distal sealable circumferential collar and the internal walls of said blood vessel distal to said vascular defect.

3. The endovascular implant ofclaim 2, wherein said tubular body is non-elastic.

4. The endovascular implant ofclaim 2, wherein said proximal sealable circumferential collar is elastic.

5. The endovascular implant ofclaim 2, wherein said distal sealable circumferential collar is elastic.

6. The endovascular implant ofclaim 2, wherein said proximal variable sealing device which is operated by a proximal control lead that traverses said main implant delivery catheter and exits at said external end for interface by said operator.

7. The endovascular implant ofclaim 2, wherein said distal variable sealing device which is operated by a distal control lead that traverses said main implant delivery catheter and exits at said external end for interface by said operator.

8. The endovascular implant ofclaim 2, wherein said tubular body may be straight.

9. The endovascular implant ofclaim 2, wherein said tubular body may branch into two or more branches.

10. The endovascular implant ofclaim 2, wherein said endovascular implant may be connected to one or more other endovascular implants in a variably sealable manner by operation of said proximal and distal sealable circumferential collars as controlled by said proximal and distal variable sealing devices, respectively, to achieve a fluid-tight seal between the proximal-most proximal sealable circumferential collar, the distal-most distal sealable circumferential collar and the internal walls of said blood vessel distal to said vascular defect.

11. The endovascular implant ofclaim 2 wherein said endovascular implant may be of solid construction of a biocompatible material.

12. The endovascular implant ofclaim 2 wherein said endovascular implant may be of woven construction of a biocompatible material.

13. The endovascular implant ofclaim 2 wherein said endovascular implant may be coated with a biocompatible material.

14. A method of treating a vascular defect such as an aneurysm in a blood vessel within a patient by an operator, comprising:

placing an elongated main implant delivery catheter with an external end and an internal end through a peripheral vascular entry into a blood vessel with internal walls;

opening or removing a main implant delivery catheter sheath at said internal end;

decompressing or unfolding a compressed or folded endovascular implant within said sheath;

employing radiographic or other real-time visualization means to monitor implant placement;

operating a proximal control lead that traverses said main implant delivery catheter and exits at said external end for interface by said operator, such that a proximal sealable circumferential collar may be expanded or contracted by said operator to achieve a fluid-tight seal; between said proximal sealable circumferential collar and the internal walls of said blood vessel proximal to said vascular defect;

operating a distal control lead that exits said main implant delivery catheter at said external end for interface by said operator, such that a distal sealable circumferential collar may be expanded or contracted by said operator to achieve a fluid-tight seal between said distal sealable circumferential collar and the internal walls of said blood vessel distal to said vascular defect;

removing said proximal and distal control leads and said main implant delivery catheter through said peripheral vascular entry.

15. The method ofclaim 14, further comprising, connecting one or more endovascular implants in a variably sealable manner by operation of said proximal and distal sealable circumferential collars as controlled by said proximal and distal variable sealing devices, respectively, to achieve a fluid-tight seal between the proximal-most proximal sealable circumferential collar, the distal-most distal sealable circumferential collar and the internal walls of said blood vessel distal to said vascular defect.

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